A GP refusing Right to Choose does not mean the door is closed. There are clear, proven steps to get your referral.
If your GP refuses a Right to Choose referral for ADHD, ask for the refusal in writing, present stronger evidence, request to see another GP, or escalate formally. Right to Choose is a legal right under the NHS Act 2006 - it cannot be overridden by practice policy.
Most GPs are not acting in bad faith. They are often working with limited information, outdated guidance, or internal pressures. Understanding why they said no helps you respond effectively.
Many GPs have had little to no training on adult ADHD and are unfamiliar with Right to Choose as a referral pathway. They may genuinely not know it exists or how it works.
Some surgeries have internal policies that discourage or block Right to Choose referrals. These policies do not override the law, but the GP may not realise that.
ICBs (Integrated Care Boards) sometimes push back on Right to Choose referrals because of cost. This pressure can filter down to individual GPs, even though funding is legally required.
In rare cases, a GP may believe your symptoms are better explained by another condition. This is a valid clinical judgement, but it does not remove your right to seek a second opinion.
If your GP has refused your Right to Choose referral, work through these levels in order. Most people resolve it within the first three steps.
Request that your GP puts their reason for refusing in writing. This alone often changes the conversation. GPs are less likely to refuse when they know it will be documented. Ask for the reason to be added to your medical record.
Complete the ASRS (Adult ADHD Self-Report Scale) screening questionnaire. Write down specific examples of how ADHD symptoms affect your work, relationships, finances, and daily functioning. Bring this documentation to your next appointment.
Politely remind your GP that Right to Choose is established under Section 75 of the NHS Act 2006. You have a legal right to choose your NHS-funded provider when waiting times exceed 18 weeks. Ask them to confirm whether your local wait exceeds this threshold.
You are entitled to see a different GP within the same surgery. Call the practice and ask to book with another doctor. You do not need to explain why. A fresh perspective often resolves the issue.
If the whole practice is blocking you, register with a new GP surgery. This is straightforward and can be done online in most areas. You do not need permission from your current practice to leave.
File a formal complaint with the practice manager first. If that does not resolve it, escalate to NHS England or your local ICB. A formal complaint creates a paper trail and is taken seriously. Use the template letter below.
"Where a patient is referred for a first outpatient appointment, the patient has the right to choose any clinically appropriate provider of NHS-funded care."
This is not guidance. It is not optional. It is a legal right established in primary legislation. Your GP cannot override it with practice policy or personal preference.
The 18-week referral-to-treatment standard means that if your local NHS ADHD service has a wait longer than 18 weeks (almost all do), you are automatically eligible for Right to Choose. You do not need to prove hardship or special circumstances.
If your GP still refuses after you cite this, they are acting outside the law. That is when formal escalation becomes appropriate.
Copy and personalise this letter. Send it to the practice manager, or to NHS England if the practice has already failed to resolve the issue.
[Your name]
[Your address]
[Date]
Dear [Practice Manager / NHS England],
I am writing to formally complain about the refusal of my Right to Choose referral for an ADHD assessment.
On [date], I attended an appointment with [GP name] at [practice name] and requested a referral to [provider name] under my Right to Choose, as set out in Section 75 of the NHS Act 2006.
My request was refused. The reason given was: [state the reason, or "no written reason was provided"].
I understand that Right to Choose is a legal right, not a discretionary service. The current waiting time for ADHD assessment through my local NHS service exceeds 18 weeks, which means I am eligible for Right to Choose. The provider I have chosen is NHS-funded and accepts Right to Choose referrals.
I would like this complaint to be investigated and for the referral to be processed as a matter of urgency.
I look forward to your response within [14 / 28] working days.
Yours sincerely,
[Your name]
In a small number of cases, a GP may have valid clinical grounds for not making a referral. This does not mean your Right to Choose is removed, but it may mean the GP believes a referral is not clinically appropriate at this time.
Even in these cases, you can ask for a second opinion from another GP, or request that both conditions are investigated in parallel.
If you have exhausted the escalation process and still cannot get a referral, there are other ways forward.
A private assessment typically costs between 500 and 2,000. It is faster, but it is out of pocket. If you are diagnosed privately, you can then ask your GP for shared care, which means your GP prescribes and monitors your medication on the NHS.
A different practice may have a completely different attitude to Right to Choose. Some practices process these referrals routinely. Moving is free and can be done online.
Organisations like ADHD UK, ADHD Foundation, and ADDISS can provide advice, advocacy, and sometimes help you navigate difficult GP interactions. Some offer template letters and escalation support.
Healthwatch is the independent champion for people using health and social care services. They can advise on complaints, signpost services, and sometimes intervene on your behalf.
A GP can refuse to make a referral if they believe it is not clinically appropriate. However, they cannot refuse Right to Choose itself. If they agree a referral is warranted, you have the legal right to choose which NHS-funded provider it goes to. If they refuse the referral entirely, ask for their reasoning in writing and escalate if necessary.
A formal complaint to the practice manager should receive a response within 14 to 28 working days. If you escalate to NHS England, the process can take several weeks longer. In practice, many complaints are resolved at practice level once the formal process is triggered.
Yes, but do so politely and constructively. Most GPs respond well when you show that you have done your research. Mention Section 75 of the NHS Act 2006 and the 18-week referral standard. Framing it as "I understand this is my legal right" is more effective than "you are breaking the law."
For Right to Choose, no. You need a GP referral. The GP is the gatekeeper for NHS-funded services. If your GP will not refer you, your options are to see a different GP, switch practices, or pursue a private assessment which does not require a GP referral.
A formal complaint is a factual, professional process. It should not affect the quality of care you receive. GPs are used to working within complaints processes and are bound by professional standards regardless. If you are uncomfortable, you can always switch to a different GP within the same practice or move to a new surgery entirely.
Right to Choose is just one piece of the puzzle. My ADHD Path gives you step-by-step guidance through the entire journey, from GP conversations to assessment, diagnosis, medication, and beyond.